Patients who receive an augmented reality (AR) walkthrough of their procedure process prior to surgery have significantly lower preoperative anxiety than those who receive standard education materials. These findings are reported in a novel clinical trial investigating the effect of AR on patient anxiety and experience in an outpatient surgical setting, published by JAMA Network Open.
Study participants were patients from the University of Miami, Miami, Florida, scheduled to undergo elective, outpatient orthopedic surgery. Participants were randomly assigned to receive either standard care or the AR intervention prior to undergoing surgery. The control group that received standard care was given the standard surgical instruction packet alone, while the AR group received the standard surgical instructions in addition to the AR intervention. The AR experience provided these participants with a visual walkthrough of their trip to the operating room, as narration was provided by their surgeon via the AR headset. The entire intervention lasted approximately 3 minutes. Anxiety levels were measured 4 times throughout the study using the State-Trait Anxiety Inventory (STAI). These surveys were administrated at screening (baseline), postintervention, prior to the operation, and following the operation. The primary endpoint of the study was the difference in STAI scores from the screening survey to the preoperative survey.
A total of 95 patients were included in the analyses, with 46 randomly assigned to the AR intervention and 49 randomly assigned to the control group. The average baseline STAI score did not significantly differ between the AR (35; SD, 9.8) and control (35; SD, 12) participants, and there were no significant differences in the demographic or clinical factors between the groups.
There was a significant mean difference in STAI score between the AR and control groups at both the postintervention (P =.01) and preoperative (P =.01) assessments. From baseline to postintervention assessment, participants who received AR exhibited a decrease of 3.1 STAI points (SD, 5.7; 95% CI, −5.0 to −1.1) while control participants showed no change (0.1; SD, 3.7; 95% CI, −1.2 to 1.3). At the preoperative evaluation, the AR group again showed a decrease of 2.4 points (SD, 7.3; 95% CI, −4.6 to −0.3) from baseline. However, the control group’s mean difference increased by 2.6 points (SD, 8.4; 95% CI, 0.2 to 4.9) at this time point. No significant differences were found in STAI scores from screening to postoperative surveys in either group and no differences were found between groups with respect to postoperative pain or narcotic pill use.
These data suggest that the administration of AR surgical instructions could help to reduce preoperative anxiety in patients. Study authors noted, “The ultimate goal of our AR experience was to educate and prepare the patient for what to expect, potentially mitigating the cognitive and physiological burden of anxiety they perceived surrounding their surgery.”
Limitations of the study include the single-center trial design and the inclusion of solely English-speaking participants. Replication of this study across multiple sites and expansion of voiceover languages are needed to confirm the generalizability of these results.
Rizzo MG Jr, Costello JP II, Luxenburg D, Cohen JL, Alberti N, Kaplan LD. Augmented reality for perioperative anxiety in patients undergoing surgery: a randomized clinical trial. JAMA Netw Open. Published online August 17, 2023. doi:10.1001/jamanetworkopen.2023.29310